Exam 5 Endocrine Flashcards
What is the action of levothyroxine?
that increase
metabolic rate, protein synthesis, cardiac
output, renal perfusion, oxygen use, body
temperature, blood volume, and growth
processes
What are indicatinos of levothyroxine?
- hypothyroidism
- for the emergency treatment of myxedema coma
(IV), a severe deficiency of thyroid hormone
with loss of homeostasis - cretinism
- simple goiter
- maintenance of thyroid hormone levels after
surgery or radiation of the thyroid
What do we teach pts on levothyroxine?
Take daily 30 minutes before
breakfast
Do not stop without provider knowing
Treatment is lifelongW
What are adverse effects of levothyroxine?
Thyrotoxicosis
Afib
Bone loss leading to fracture
Increased risk of dysrhythmias
What is hypothyroidism?
Underactive thyroid -> not producing enough hormone (disease or destruction of gland)
What are typical lab values for hypothyroidism?
high TSH, low T3, T4
What causes hypothyroidism?
Hashimoto’s thyroiditis (autoimmune disease characterized by inflammation of
gland)
Other causes -> treatment for hyperthyroidism; radiation; surgery; amiodarone therapy, lithium or iodine
What are s/s of hypothyroidism?
Decreased CO, HR, and BP; cardiac enlargement and HF;
anemia
Apathy; lethargy; emotional dullness; slow speech; dullness;
mental sluggishness; drowsy
Cold intolerant
Weight gain; decreased appetite; constipation
Weak; fatigue
Dry, course, thick skin, hair and nails
What is hyperthyroidism?
Overactive thyroid-> thyroid gland produces too much hormone (Thyroxine
What causes hyperthyroidism?
Grave’s Disease which is an
autoimmune disorder where antibodies produced by immune system stimulate thyroid to produce
too much T4
Nodular thyroid goiter -> one or more adenomas (a portion of the gland that has walled itself off
from the rest of the gland) of the thyroid produce too much T4 -> This type is increased as
people age and where there is dietary iodine deficiency
Overtreatment for hypo
What are lab values for hyperthyroidism?
ow TSH, high T3, T4
What are s/s of hyperthyroidism?
- Unintentional weight loss; altered (increased) appetite; Abdominal cramps, diarrhea, N and V
- Tachycardia/palpitations, increased cardiac output, dysrhythmias, HF
- Nervous, emotional instability, restless, anxiety, insomnia
- Heat intolerance; fever; diaphoresis ; soft hair and nails; exopthalamus
- THYROID STORM: Thyrotoxic crisis -> rare but serious; typically if poorly treated or undiagnosed or if treated well bu
- body in stress
What are adverse effects of methimazole?
Overmedication can result hypothyroidism
Agranulocytosis –severe ↓ WBC (sore throat, fever)
Liver injury, hepatitis
What do we teach pts on methimazole?
Oral admin.
Monitor vital signs, weight, and I&O at baseline and periodically.
Monitor thyroid levels before, during, and after therapy.
Monitor for s/s of hyperthyroidism (indicating inadequate medication)
What do we give pts with hyperthyroidism for tremors and tachycardia?
Clients who have hyperthyroidism may be given a beta-adrenergic antagonist (propranolol) to decrease tremors and tachycardia
What are s/s of cretinism?
sluggish
pale/gray, cool skin
nonpitting myxedema
constipation
large tongue
poor muscle tone
mental retardation
dry, brittle hair
What are indications for propylthiouracil?
hyperthyroidism
Graves’ disease
What do we teach pts on propylthiouracil?
Therapeutic effects can take 1 to 2 weeks to be evident, while full benefit can take 3 to 12 weeks
What are s/s of Graves’ disease?
bulging eyes
enlarged thyroid
heat intolerance
anxiety
What are advers effects of iodine?
Radiation Sickness
Bone marrow depression-leukemia may be induced
Hypothyroidism
What are indications for radioactive iodine?
High doses:
Hyperthyroidism
Thyroid cancer
Clients who have not responded to other antithyroid treatments
What are adverse effects of radioactive iodine?
Radiation Sickness
Bone marrow depression-leukemia may be induced
Hypothyroidism
What are contraindications for radioactive iodine?
Use is contraindicated in pregnancy (Pregnancy Risk Category X), clients of childbearing age/intent, and during lactation
What are pt teaching points for radioactive iodine?
Instruct clients to report manifestations of hypothyroidism to the provider
Discontinue use of other antithyroid medications for a week prior to therapy
Clients and secretions will be radioactive until the iodide decays
